20041008.pdfDATE RECEIVED
I [PERMIT EXPIRES
PERMIT
CITY OF EDMONDS NUMBER
CONSTRUCTION PERMIT APPLICATION JOB SUITE/APTa
ADDRESS
OWNER NAMEINAME OF BUSINESS _,C - 7 j- (A'J
C-Pmvtjo PLAT NAMEISUBDIVI SION NO, LOTNO LID NO
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved
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1-7 4 z-i LA pi iF A d(EE- - �t Street Use Permit Requited 13
CITY ZIP TELEPHONE Z-40 (a — EXISTING PROPOSED Inspection Requited 13
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REQUIRED DEDICATION FT Umaotground C3
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NAME METER SIZE E SIZE NO, OF FIXTURES PRV REQUIRED
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OWN E RICON TRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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STATE LICENSE NUMBER EXPIRATION DATE "CHE REO'D COMPLETED EXEMPT
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LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT.)
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COMMERCIAL COMPLIANCE OR z
ADDITION MIXED USE CHANGE OF USE z
PARKING LOT AREA PLANNING REVIEWED BY DATE
REMODEL E] MULTIFAMILY SIGN REO'D I PROVIDED (L
El REPAIR ED GRADING o FENCE
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DEMOLISH TANK 1:1
GARAGE o RETAINING WALL FIRE aK
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DESCRIBE WORK TO BE DONE
REMARKS
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STRUCTURAL DESIGN
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Des&iption FEE Description FEE
10�qx Plan Check State Surcharge
HEATSOURCE LOTSLOPE% VESTED DATE Building Permit City Surcharge
PLAN CHECK NO: Plumbing Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical
I- BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
Engr. Review
rz PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
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CL PERMIT LIMIT. SEE ECDC 19.00.005(A)(6) Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
*APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk, Deposit
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U.1 IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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2 EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapelnsp. Total Amt. Due
_5 6-
401 NOR LIMIT IN ANY WAY THE CITY's ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
x Recording Fee i Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF This application is not a permit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRLIC- CALL Building Official or hisiher Deputy and Feesare paid and
TION; AND IN DOING THE WOR UTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED receipt is acknowledged in space provided
IU FOR INSPECTION
IN VIOLATION OF THE LAB '64E OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSAT FFI IGNAT DATE
fINSUR I CE AND RCW 18:27.
SIGNATURE OWNFR ORA NT): DA E SIGNED (425)
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771-0220 RE Y ()ATE
ATTENTION EXT. 1333 ..1-
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
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A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINAL - FILE - YELLOW - INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 I IRC1110. PINK -OWNER - GOLD - ASSESSOR
10/04 PRESS HARD - YOU ARE MAKING 4 COPIES
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MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PLE,VSr SIGN
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PLANNING DIVISION DATE
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PROJECT L D 42
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DESCRIPTION OF WORK TO BE INSPECTED
A field inspection was conducted to determine compliance with -approved plans. Final approval
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signawre
1:temp:b1dg:r6mis:ocapn,1 3/25/04
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
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Retaining Wall ...........
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Slab Insulation ..........
PLUMBING:
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Underground .............
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Rough -In ...................
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HEATING:
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Gas Test ....................
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EXTERIOR SHEATHING
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FRAMING ........................
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FIRST FLOOR FRAMING ...
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INSULATION ...................
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SHEETROCK NAILING ...
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SPECIAL INSPECTION
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OCCUPANCY ..................
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